Areas Of Clinical Practice Research Articles

The Perceptions and knowledge of Physiotherapist regarding exercise and joint health in India

BACKGROUND:
 A physiotherapist plays a key role in assessing, monitoring, educating and prescribing exercise for RA. A few previous surveys across the goble emphasized on the lack of evidence to guide physiotherapist recognizing the early signs of RA, in knowledge of disease course, and in evidence-based interventions and therefore the ability to manage an individual with RA over the course of the disease. The study aims to investigate physiotherapists’ current practice in specific disease-related Knowledge and clinical skills required managing people with RA and extent to which they promote physical activity and exercise.
 
 METHOD:
 A cross-sectional national e-survey was sent to physiotherapists regarding their confidence in managing RA patients. Questionnaire Data developed from previous literatures included the following details: years of clinical experience, current RA clinical caseload, and professional qualifications, primary clinical area of practice, relevant treatment options in established or newly diagnosed cases and management goals.
 
 RESULT:
 A total of 478 physiotherapist responses were received.84% agreed to the fact that exercises does play an important role in joint health promotion. Almost 70% strongly agreed to factor that FIIT principal has to be taken in consideration while prescribing exercises. Approximately 48% were familiar with Index that measures disease activity and ACR-preferred tools for functional status assessment in RA. Moreover, 98% were having a clear perspective of different guidelines of management in RA and Osteoarthritis (OA).While considering the choice of treatment physical activity and educational advice were more preferred as compared to the modalities or manual therapy.
 
 CONCLUSION:
 The present practices are in lines with the current guidelines for RA management, but still most of them never prescribed high-intensity exercise and lacked knowledge of when to advice appropriate splints/orthoses. Even the recommendations regarding splints were not clear. So, there's a requirement to develop education and training for constantly upgrading physiotherapists within for the promotion of physical activity in rheumatoid arthritis patients.
 
 
 

Transitioning From Training to Breast Imaging Practice: Building an Academic Career.

Launching an academic career in breast imaging presents both challenges and opportunities for the newly graduated trainee. A strategic plan aligned with one's personal strengths and interests facilitates career success and professional satisfaction. Academic departments offer multiple tracks to accommodate diverse faculty goals. The specific requirements of various tracks vary across institutions. The clinician-educator track typically encourages a focus on medical education and educational scholarship. The clinician-investigator or clinician-scholar track supports original research and grant-funded clinical trials. Finally, the clinical and clinician-administrator tracks allow for emphasis on clinical program development and leadership. As definitions of scholarship broaden, many opportunities are accessible to demonstrate excellence in the traditional areas of clinical practice, education, and research, as well as the broader fields of leadership and administration. Departmental and national society resources that advance knowledge in one's chosen area of interest are available and should be explored. Mentorship and sponsorship can provide valuable insight into identifying such resources and devising a plan for sustainable career success and work-life integration.

Blood Rheology Alterations in Patients with Cardiovascular Diseases.

Blood rheology is an important determinant of blood flow but is probably one of the most neglected areas in clinical literature and practice. Blood viscosity changes according to shear rates and depends on cellular and plasma factors. RBCs' aggregability and deformability are the main determinants of local flow characteristics in areas with lower and higher shear rates, but plasma viscosity is the main regulatory factor of flow resistance in the microcirculation. In individuals with altered blood rheology, the mechanical stress to vascular walls induces endothelial injury and vascular remodelling, and promotes atherosclerosis. Increased values of whole blood viscosity and plasma viscosity are correlated with cardiovascular risk factors and adverse cardiovascular events. The long-term effects of physical exercise can produce a hemorheological fitness that protects against cardiovascular diseases.

The Role of Patient-Reported Outcomes in Sleep Measurements.

Several questionnaires aka patient-reported outcome measures (PROMs) have been developed for specific use in sleep medicine. Some PROMS are "disease-specific," that is, related to a specific sleep disorder, whereas others are generic. These PROMS constitute a valuable add-on to the conventional history taking. They can be used in the areas of research, clinical practice, and quality of health care appraisal. Still, these instruments have inherent limitations, requiring proficient application in the various areas of interest. Disease-specificity includes a risk for nosologic bias that may confound diagnostic and therapeutic results. Future research should provide solutions for shortcomings of presently available questionnaires.

Common practices among consistently high-performing in vitro fertilization programs in the United States: 10-year update

To evaluate similarities and differences in clinical and laboratory practices among high-performing fertility clinics. Cross-sectional questionnaire study of selected programs. Academic and private fertility practices performing invitro fertilization (IVF). Not applicable. A comprehensive survey was conducted of 13 IVF programs performing at least 100 cycles a year and having high cumulative singleton delivery rates for 2 years. Clinical and laboratory IVF practices. Although many areas of clinical practice varied among top programs, some commonalities were observed. All programs used a combination of follicle-stimulating hormone and luteinizing hormone for IVF stimulation, intramuscular progesterone in frozen embryo transfer cycles, ultrasound-guided embryo transfers, and a required semen analysis before starting the IVF cycle. Common laboratory practices included vitrification of embryos at the blastocyst stage, air quality control with positive air pressure and high-efficiency particulate air filtration, use of incubator gas filters, working on heated microscope stages, and incubating embryos in a low-oxygen environment, most often in benchtop incubators. Some areas of consistency in clinical and laboratory practices were noted among high-performing IVF programs that are likely contributing to their success. High-performing programs focused on singleton deliveries. As the field of IVF is rapidly evolving, it is imperative that we share best practices in an effort to improve outcomes from all clinics for the good of our patients.

Anaesthesia skills and simulation training during the COVID-19 pandemic

Due to COVID-19 restrictions in the clinical practice areas and theatres of the Academic hospitals in Bloemfontein (South Africa), 4 th and 5th-year medical students of the University of the Free State had limited access to routine clinical and emergency cases. As part of their Anaesthesia rotation, students needed access and exposure to these clinical and emergency cases to fulfil the minimum training requirements set out in their curriculum. These included ultrasound techniques, administration and management of patients for general anaesthesia and administration of spinal anaesthesia, airway management and Cardiopulmonary Resuscitation (CPR).

Analyzing Evidence on Interventions to Strengthen the Clinical Support for Midwifery Students in Clinical Placements: Protocol for a Systematic Scoping Review

BackgroundThe benefits of clinical support are evident in various mentorship, preceptorship, or clinical supervision models. Poor collaboration between lecturers and clinical staff, lack of confidence about student support, large student intakes coupled with core demands create negative attitudes toward student supervision, and this poses a huge challenge to midwifery students who are expected to become competent in the process.ObjectiveThis study aims to identify and analyze interventions, strategies, and/or mechanisms in order to strengthen the clinical support for midwifery students in clinical practice areas from a global perspective.MethodsThis review will follow the Arksey and O’Malley framework (2005). The search strategy will include primary studies searched for in electronic databases such as EBSCOhost (CINAHL, MEDLINE, and Health Source: Nursing/Academic edition), PubMed, Google, and Google Scholar. Keywords such as “midwifery students,” “midwifery education,” and “clinical support” will be used to search for related articles. The search will include articles from the cited by search, as well as citations from the reference list of included articles. All title-screened articles will be exported to an EndNote library, and duplicate studies will be removed. Two independent reviewers will concurrently carry out the abstract and full-text article screening according to the eligibility criteria. Extracted data will highlight the aims, geographical setting, and level of training; intervention outcomes; and the most relevant and most significant findings. This review will also include a mixed methods quality appraisal check. A narrative summary of data extracted will be analyzed using content analysis.ResultsInterventions to strengthen the clinical support for midwifery students in practice will be extracted from this review, and data will be analyzed and extracted to develop a comprehensive guide or framework for clinical mentorship. As of August 2021, the electronic search, the data extraction, and the analysis have been completed. The results paper is expected to be published within the next 6 months.ConclusionsIt is expected that this review will contribute to midwifery education by identifying quality evidence on clinical support interventions available to midwifery students globally, as well as best practice methods, procedures, or interventions that can be used to develop a midwifery mentorship training program.International Registered Report Identifier (IRRID)DERR1-10.2196/29707

Perceptions of training, self-efficacy, and mentoring among veterinary clinical specialty trainees

To determine the perceptions of training, self-efficacy, and mentoring among veterinary clinical specialty trainees on the basis of their career interest. 207 veterinarians who were either in a residency training program or had recently (within 2 years) completed one in a specialty recognized by the American Board of Veterinary Specialties. An online survey was used to collect data about the respondents' perceived preparedness for an academic career, training emphasis, and mentoring received during training and demographic information. Results were compiled and compared by professional career interest (ie, academic medicine or private practice) and gender. Included respondents represented 20% (207/1,053) of those invited. Preferred career choice was academic medicine for 48% (93/194) of respondents and private clinical practice for 52% (101/194) and did not differ by gender. Respondents perceived their likelihood of success in an academic career as high, and these perceptions did not differ by gender or preferred career choice. Mean self-efficacy scores for teaching were high among all respondents for most but not all listed teaching skills and did not differ by gender or preferred career interest. Mean self-efficacy scores were low for formulating research hypotheses and designing studies. Perceptions of training emphasis indicated strong mentoring in the areas of clinical practice and teaching with less mentoring and training emphasis in multiple areas of research and academic activity. Lower self-efficacy of veterinary clinical specialty trainees in aspects of academic career appeared to be related to training emphasis and mentoring. Enhancement of emphasis on the identified areas of weakness may improve the interest and success of trainees in an academic career.

Use of thyroid hormones in hypothyroid and euthyroid patients: a THESIS* questionnaire survey of Polish physicians. *THESIS: Treatment of hypothyroidism in Europe by specialists: an international survey.

Over the past several years new evidence on the management of hypothyroidism has emerged, which has influenced recommendations from professional bodies. The presentation of hypothyroid patients has also changed, and new cases are increasingly diagnosed by indiscriminate screening, often identifying cases with minor biochemical disturbances. Little is known about the physician responses and attitudes to this changing landscape. THESIS (Treatment of Hypothyroidism in Europe by Specialists: an International Survey) is a large-scale survey of European physicians who treat patients with hypothyroidism. Here we document current practices of Polish physicians relating to the use of thyroid hormones in hypothyroid and euthyroid patients. Members of the Polish Society of Endocrinology were invited to participate in the web-based THESIS survey. In total 423 (54.6% of the 774 invited) physicians completed the survey. The majority of respondents (74.2%) would prescribe thyroid hormones foreuthyroid patients for certain indications, such as female infertility with elevated thyroid antibodies (63.4%), simple goitre (40.9%), unexplained fatigue (12.1%), obesity (9.7%), hypercholesterolaemia (9.0%), and depression (9.2%). Nearly all physicians (96.0%) declared that the treatment of choice for hypothyroidism is levothyroxine (LT4). However, around one-third (30.3%) were also using LT4 and liothyronine (LT3) combination treatment; LT3 alone was rarely prescribed (1.7%), and none prescribed desiccated thyroid extract. The majority of respondents preferred LT4 tablets. Among alternative formulations, liquid LT4 was most commonly recommended for patients unable to take LT4 in the fasting state (26.0%) and patients with malabsorption (19.9%). Respondents considered prescribing dietary supplements (such as selenium and iodine) in hypothyroid patients with coexisting autoimmune thyroiditis (29.6%) or at the patients' request (32.2%). LT4 + LT3 combination therapy was used by 32.2% when symptoms persisted notwithstanding normal serum TSH concentration. Psychosocial factors, comorbidities, and the burden of chronic disease were considered as the most likely causes of persistent symptoms. Apart from clinical practice recommendations, other factors influence the thyroid hormone therapy patterns. Moreover, certain areas of clinical practice were identified (the use of thyroid hormones in euthyroid subjects and the use of dietary supplements), which are not in accordance with the current evidence.

Non-violent resistance and family accommodation: A trans-diagnostic solution to a highly prevalent problem.

The goal of this study is to integrate two areas in recent clinical theory, research, and practice: family accommodation and non-violent resistance (NVR). Family accommodation describes changes that family members make to their own behavior, to help their relative who is dealing with psychopathology to avoid or alleviate distress related to the disorder. Rapidly growing research on family accommodation has established its high prevalence and negative impact across disorders and the life span. NVR is a trans-diagnostic treatment approach that helps parents to cope with child externalizing, internalizing, and other problems in non-escalatory ways. This study reviews empirical research on family accommodation and NVR, and argues that the anchoring function of NVR, a central concept reflecting the stabilization of the parent-child relationship, may provide a uniquely suited framework for reducing family accommodation across disorders and development. The study discusses how the anchoring function may be applied to promote accommodation reduction through a detailed description of SPACE (Supportive Parenting for Anxious Childhood Emotions), an NVR-informed treatment for childhood anxiety and obsessive-compulsive disorder.

Undergraduate nursing students’ transformative learning through disorientating dilemmas associated with end-of-life care simulation: A narrative inquiry study

BackgroundDespite attempts, there remains a theory practice gap for undergraduate nursing students transitioning to clinical practice on graduation, especially for specialty areas of clinical practice, such as palliative care, where there are limited opportunities to gain specialty knowledge and skills. As a result, undergraduate nursing students largely feel unprepared for end-of-life care in clinical practice. End-of-life care simulation is gaining momentum for helping prepare students to undertake this important care. However, little is known of whether end-of-life care simulation is a transformative learning strategy that can be transferred to clinical practice. AimThe aim of this paper is to report on undergraduate nursing students transformative learning through end-of-life care simulation. DesignA qualitative research design using narrative inquiry was used with data collected through semi-structured interviews and analysed using Clandinin and Connelly’s three dimensions of narrative inquiry. MethodsEighteen 3rd year undergraduate nursing students enrolled in a compulsory palliative care unit, at an Australian university participated in an immersive end-of-life care simulation. Data were collected through semi-structured interviews and analysed using Clandinin and Connelly’s three dimensions of narrative inquiry. ResultsThis study revealed that transformative learning occurred through three disorientating dilemmas of: caring for a dying patient; approaching difficult conversations; and witnessing death for the first time. Knowledge of palliative care and clinical skills were also found to be transferred to clinical practice. ConclusionsEnd-of-life care simulation can be an effective method of promoting transformative learning and can help to reduce the gap from nursing theory to clinical practice.

Clinical supervisors’ perceptions of podiatry students’ preparedness for clinical placement and graduates’ preparedness for podiatry practice in Australia: An exploratory study

Introduction: Little is known about Australian podiatry students’ preparedness for clinical placement and graduates’ preparedness for clinical practice. This qualitative study explored clinical supervisors’ perceptions of podiatry students’ and graduates’ preparedness-related challenges and their recommendations for improvement.Methods: Eleven registered podiatrists who had supervised or were still supervising students were interviewed. Transcribed interviews were thematically analysed. Benner’s (1984) stages of clinical competence from novice to expert informed the study.Results: Clinical supervisors were divided about students’ preparedness for clinical placements, with their perceptions ranging from generally prepared (n = 2) to unsure (n = 5) to unprepared (n = 4). They commented on junior versus senior students, institutional differences and specific clinical skill deficiencies, e.g., scalpel debridement and patient communication skills. Perceived challenges for students on placement included poorly developed clinical skills and low self-efficacy, both stemming primarily from insufficient hands-on experience. Participants suggested that for improved placement preparedness, students required better quality clinical experiences and communication skills training. Being work-ready, which most graduating Australian podiatrists were reported to be, involved being safe and self-efficacious. Participants also suggested that a supportive clinical environment, an internship and more advanced interpersonal skills would facilitate preparedness. Conclusion: In terms of Benner’s (1984) framework, during training, podiatry students should be considered novices, and they should be considered advanced beginners on graduation. An entry-level graduate should not be expected to be competent across all areas of clinical practice. Hands-on clinical practice during placements was needed for moving successfully through Benner’s (1984) stages of clinical competence. While clinical supervisors believed that podiatry training generally prepared students for clinical practice immediately following graduation, they asserted that manual clinical and communication skills improvement is required for clinical placements.

Enhancing Support for Women in Cardiothoracic Surgery Through Allyship and Targeted Initiatives

BackgroundIssues of diversity, equity, and inclusion in cardiothoracic surgery have garnered increased attention. Although barriers persist for women in our field, they may be ameliorated through enhanced support from allies. We aimed to determine best practices for allyship to better support female cardiothoracic surgeons. MethodsA survey was electronically distributed to members of Women in Thoracic Surgery, addressing presence of female colleagues, sense of allyship among colleagues and leadership, and supportive versus detrimental characteristics of colleagues. Qualitative responses were grouped and coded to identify key themes. ResultsOf 309 Women in Thoracic Surgery members, 87 (28%) responded. More than half of respondents felt supported by their male colleagues in the areas of clinical practice, research, teaching, and personal life. Whereas 64% of respondents considered at least one woman in their division an ally, only 48% considered at least one man in their division an ally, and 53% considered their division chief or department chair an ally. A theme of mentorship, support, and sponsorship was reported as the most important quality of allies, regardless of gender. A theme of disrespect, discrimination, stereotyping, and unconscious bias was reported as the most detrimental characteristic of male colleagues, whereas a theme of competitiveness and undermining was reported as the most detrimental of female colleagues. Initiatives to enhance support for female cardiothoracic surgeons were identified, with increased access to mentorship and sponsorship consistently identified as an important endeavor. ConclusionsIncreasing access to mentors, promoting positive behavior, and minimizing detrimental behavior may enhance support for female cardiothoracic surgeons.

Women's and men's health physiotherapy, the content covered and it's perceived importance within entry-level physiotherapy programs in Australia – an observational study

Purpose Women’s and men’s health physiotherapy are expanding areas of clinical practice. The aims of this study were to examine the course content and its perceived importance of specific content on women’s and men’s health within physiotherapy programs and identify any barriers to delivering the content. Methods An online survey, with open and closed questions was distributed to universities in Australia with an entry-level physiotherapy program, in 2019. The ‘Likert’ scale responses were then analysed by assigning a scale from 1–5. The open responses were descriptively analysed for themes. Results There were 15 responses from the 22 university programs in Australia. Content that should be covered ‘well’ to ‘very well’ include pelvic floor first exercise; pelvic floor anatomy; incontinence urinary and bowel; exercise – during pregnancy and post-natal; pelvic girdle pain; pelvic organ prolapse; rectus diastasis; osteoporosis; the role of physiotherapist in maternity ward; and pelvic floor muscle assessment-external with real time ultrasound; and in men’s health: male culture and pelvic health; and prostate cancer pre and post-surgical rehabilitation. A barrier to teach content for some courses included space within the curriculum. Clinical placements and research projects were not available in all programs. Conclusion Women’s and men’s health content is perceived to be important to be taught in entry level physiotherapy programs. Identifying what is perceived important content to cover may assist future curriculum design.

Personalisation of a virtual gaming system for children with motor impairments: performance and usability

Purpose To demonstrate the potential role of virtual game personalisation for use as a therapeutic modality to improve upper extremity function in children with cerebral palsy (CP). Methods The study tested a convenience sample of 60 typically developing children (TD) aged 6–10 years and 20 children with CP aged 7–11 years. Children participated in a single 30-min session when they played the game in accuracy mode (virtual targets are hit as they become progressively larger or smaller) or dwell mode (virtual targets are hit when the users remains on them for progressively shorter or longer durations). These two modes can be played in conventional (non-personalised), personalised and with and without arm weights conditions; weights were used for the TD group in order to ensure that game play would be sufficiently challenging as to require personalisation. We measured performance variables (frequency of changes in game level difficulty and accuracy as measured by percent success of hitting the virtual targets) in each condition and usability variables (self-reported perceived effort and enjoyment). Results Comparisons between the usability of the conventional and personalised conditions among typically developing children showed that although children self-reported significantly more effort while playing the personalised game, the level of enjoyment remained high (no significant differences between conventional and personalised game play conditions). In addition, comparisons between playing the personalised game with and without weights by typically developing children, indicated that percent success was significantly higher for the game played without weights, suggesting that the system is sensitive to dynamic changes in performance. Comparisons between the TD and CP groups showed that when the game was played in personalised dwell mode (hovering over the target for several seconds) children with CP progressed significantly less quickly through different difficulty levels compared to typically developing children. In contrast, no significant differences were found in accuracy mode (immediate response on target hit), between the TD and CP groups in any of the experimental conditions. Discussion The personalised game approach was shown to be enjoyable for both groups of users and able to change the level of difficulty in real time. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment. Conclusion Personalised virtual therapy shows promise as a tool for upper extremity therapy for children with motor impairment. Implications for Rehabiliation In recent years, there has been an increase in the use of assistive technologies including virtual gaming in the general area of health care and clinical practice. Virtual gaming provides an interactive, real-time experiences that are flexible and ecologically valid ways to improve specific cognitive and motor abilities. Personalisation of virtual games entails dynamic adaptation of the parameters in real time according to the user’s functional level). The results have demonstrated that personalised virtual gaming is enjoyable and feasible for typically developing children and children with cerebral palsy. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment.

Addressing patient sexuality issues in cancer and palliative care.

The impact of cancer and subsequent treatments can have serious implications for patient sexuality, both physically and psychologically. Patients report inadequate communication and support from professionals in relation to sexual issues. The aim of this literature review was to ascertain the educational requirements of health professionals practising in oncology and palliative care, to enable effective assessment and support in this area of clinical practice. There appear to be numerous barriers preventing professionals from addressing patient sexuality-lack of knowledge and poor confidence levels being among the most common. Appropriate education is required to equip staff, and it appears that short training programmes can be effective. The use of sexuality assessment tools and information cards, and accessing information from cancer charity websites may improve clinical practice. Addressing sexuality concerns is the responsibility of each person in the multidisciplinary team. Patients require open discussion and professionals must skilfully address the topic of sexuality. Education in this area must be accessible, cost effective and sustainable.

Physiotherapy and pelvic floor health within a contemporary biopsychosocial model of care: From research to education and clinical practice.

BackgroundPelvic floor dysfunction (PFD) is a common problem in both men and women. Despite the high prevalence and negative effects on quality of life, there is still a lack of research in this area which translates into clinical practice and education.ObjectivesMy study discusses how gaps and controversies in current research and evidence on PFD might be addressed by positioning PFD within a contemporary biopsychosocial model of care (BPSM).MethodVarious databases were searched for relevant studies published between 2010 and 2020 to support hypotheses and statements.ResultsMy study focuses on the available evidence of PFD in both men and women as related to the themes and sub-themes of the BPSM, and how this available evidence might translate into education and clinical practice. It highlights areas of research, education and clinical practice that need to be explored and how the different components of healthcare may influence one another.ConclusionBiomedical aspects regarding pelvic health are mostly investigated and taught, whilst psychological, cognitive, behavioural, social and occupational factors, individualised care, communication and therapeutic alliances are still under-investigated and not integrated or translated at a sufficient level into research, education and clinical practice.Clinical implicationsIncorporating the integration of all factors of the BPSM into research is important for effective knowledge translation and enhancement of a de-compartmentalised approach to management. The interaction between the different components of the BPSM should be investigated especially in a South African population.

Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review

BackgroundAn underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.ObjectivesTo (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.DesignA realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.Data sourcesSearches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.Review methodsRealist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.ResultsA total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.LimitationsLimitations were the low quality of included literature and limited number of UK-based studies.Future workFuture work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.Study registrationThis study is registered as PROSPERO CRD42018088779.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.

The Inaugural Issue of the Journal of Global Neurosurgery

Over the last decade, the field of Global Surgery, which some of us had termed the “neglected stepchild of Global Public Health,” has expanded to bridge the gap in surgical care. Evidence of a burgeoning field of research, practice, and cooperation abounds: the 16 countries of the Southern Africa Development Community, for example, are working together to strengthen surgical care in the region. During the most recent meeting of the World Health Organization’s Western Pacific Regional Committee, the 37 member states unanimously agreed to a regional action framework for safe and affordable surgery. A global coalition is forming to meet the need for 143 million surgical procedures in low- and middle-income countries (LMICs) by the end of the decade. 
 
 Academic institutions have an essential role and responsibility in the quest for global access to safe and affordable surgical services. In response to pressing material disparities faced by district hospitals, academic institutions can partner with the public sector and bolster access to services by helping provide the staff, space, systems, and social supports required for quality care. By conducting relevant and timely research, investigators inform the planning, financing, and implementation of surgical care delivery programs. Furthermore, specialists are well placed to bring their expertise to bear on disparities in access and outcome, and neurosurgeons are advancing research to link their area of clinical practice to broader efforts for global health equity; this includes, of course, an emphasis on forging fruitful and equitable research collaborations across the globe. To that end, I congratulate all involved in launching the inaugural issue of the Journal of Global Neurosurgery (JGNS). 

Knowledge, practices and perceived barriers of physiotherapists involved in disaster management: a cross-sectional survey of Nigeria-based and trained physiotherapists.

BackgroundDisasters represent substantial health risks to the human population. Proper interventions at all stages of disaster management (DM) are essential for human-related outcomes. The role of physiotherapy in DM should not be underestimated, but unfortunately information on the involvement of physiotherapists in DM is limited in sub-Saharan Africa.MethodsOne hundred and fifty Nigeria-based and trained physiotherapists were recruited to complete a questionnaire investigating the knowledge, practices and perceived barriers of the role of physiotherapists in DM.ResultsPhysiotherapists had moderate knowledge of their role at every stage of DM. However, their involvement in specific DM-related activities during various stages of DM in the country was low. Major barriers to the involvement of physiotherapists in DM included a lack of established government policies on the integration of physiotherapists in DM (90.0%) and a lack of specialty clinical practice areas in DM (89.3%). For improved involvement of physiotherapists in DM in Nigeria, respondents recommended creating an awareness of the role of physiotherapists in DM (91.3%), providing continuous education programmes on DM (90.6%) and inclusion of DM in physiotherapy training programmes in Nigeria (90.0%).ConclusionPhysiotherapists perceived that they are not adequately involved in DM in Nigeria, despite their moderate knowledge of their role during DM.